多模式镇痛在肝胆管结石术后的应用价值研究

发布时间：2018-01-08 19:01

本文关键词：多模式镇痛在肝胆管结石术后的应用价值研究　出处：《南华大学》2016年硕士论文　论文类型：学位论文

【摘要】：研究背景加速康复外科(enhanced recovery after surgery,ERAS)是上世纪九十年代末丹麦哥本哈根大学的Henrik Kehlet教授率先提出的概念,是指运用经循证医学已证实有效的围手术期的措施,加以优化、组合,从而达到减少外科应激、维持病人内环境稳定、加快术后康复、缩短住院时间的目的。经过多年发展,ERAS的理念逐渐被国内外医师接受,并广泛应用于胃肠外科、骨科、心胸外科、妇产科、泌尿外科等多个领域,并取得了良好的收益。肝胆管结石在我国属于多发病、常见病,而肝胆管结石病临床上处理往往复杂多变、并发症多,围手术期的管理尤为重要,将加速康复外科提倡的多模式镇痛应用于肝胆管结石术后患者,是否会使患者获益,值得进一步深入研究。目的探讨多模式镇痛应用于肝胆管结石术后的有效性及安全性,为多模式镇痛方案的推广提供科学依据。方法对肝胆管结石术后患者分别采用多模式镇痛方案(40例)和传统镇痛方案(40例)治疗,对比两组患者的术后疼痛评分情况、C反应蛋白及胰岛素抵抗指数,并对比两组术后首次下床活动时间、排气排便时间、手术后住院时间、住院费用、并发症发生情况等。结果总共72例患者完成试验,其中应用多模式镇痛的ERAS组35例,应用传统镇痛方案的传统组37例,将ERAS组与传统组对比发现,患者术后疼痛评分明显降低(P0.05),C反应蛋白降低(P0.05),胰岛素抵抗明显减轻(P0.05),首次下床活动时间、排气排便时间明显提前(P0.05),术后住院天数缩短(P0.05),住院费用减少(P0.05),术后恶心、腹胀、尿潴留发生率ERAS组比传统组低,有统计学差别(P0.05),其余发生率无区别(P0.05)。结论1、基于ERAS理念的多模式镇痛应用到肝胆管结石术后是安全有效的;2、我们采用的基于ERAS上的多模式镇痛方案(舒芬太尼PCIA+帕瑞昔布)能达到术后有效镇痛,减轻了肝胆管结石病患者术后的应激反应,减轻胰岛素抵抗,缩短患者胃肠道功能恢复时间,减少住院天数及住院费用;3、多模式镇痛能降低肝胆管结石患者术后部分并发症的发生率;4、多模式镇痛能增加术后患者对治疗的依从性,提高满意度,值得在临床进一步推广。
[Abstract]:On the background of accelerated rehabilitation surgery (enhanced recovery, after surgery, ERAS) is the first to put forward the concept of last century at the end of the 90s Henrik Kehlet professor of the University of Copenhagen in Denmark, refers to the use of evidence-based medicine has been confirmed by the effective perioperative measures to optimize the combination, so as to reduce the surgical stress, patients maintain a stable internal environment, rehabilitation accelerate the postoperative, shorten the hospitalization time of the objective. After years of development, the concept of ERAS has been the domestic and foreign doctors accepted and widely used in gastrointestinal surgery, cardiothoracic surgery, Department of orthopedics, obstetrics and Gynecology, Department of Urology and many fields, and have achieved good returns. Hepatolithiasis in our country belongs to the high incidence of common diseases. However, hepatolithiasis clinical treatment is often complicated, more complications, perioperative management is particularly important, will accelerate the application of multimodal analgesia to promote rehabilitation surgery in the liver Patients with hepatolithiasis after operation, will benefit the patients, which is worthy of further research. Objective to evaluate the efficacy and safety of multimodal analgesia applied to hepatic bile duct stones after operation, and provide scientific basis for the promotion of multimodal analgesia scheme. Methods of hepatolithiasis patients respectively using multimodal analgesia (scheme 40 cases) and conventional analgesia (40 cases) treatment, pain scores were compared between the two groups of patients with postoperative C index, C-reactive protein and insulin resistance, and compared the two groups of postoperative ambulation time, postoperative exhaust time, hospitalization time, hospitalization costs and complications. Results a total of 72 patients the end of the experiment, the application of multimodal analgesia in 35 cases of group ERAS, the application of traditional analgesia scheme of traditional group 37 cases, we found that ERAS group and traditional group, postoperative pain score was significantly lower (P0.05), C (C-reactive protein decreased P0.05), insulin resistance significantly reduced (P0.05), ambulation time, exhaust time were earlier (P0.05), shortening the duration of hospitalization after operation (P0.05), reduced hospitalization costs (P0.05), postoperative nausea, abdominal distention, urinary retention rate of ERAS group than in the traditional group, the difference was statistically significant (P0.05) the rest, there was no difference (P0.05). Conclusion: 1, based on the concept of ERAS multimodal analgesia applied to hepatolithiasis after surgery is safe and effective; 2, multimodal analgesia scheme of ERAS based on the (sufentanil PCIA+ parecoxib) can achieve effective postoperative analgesia, reduce the stress response of liver hepatolithiasis patients, reduce insulin resistance, shorten the recovery time of gastrointestinal function in patients, reduce the hospitalization days and the hospitalization expenses; 3, multimodal analgesia can decrease the incidence of intrahepatic bile duct stones in patients with posterior branch complications; 4, multimodal analgesia can increase operation The compliance of the patients to the treatment and the improvement of satisfaction are worthy of further promotion in the clinic.

【学位授予单位】：南华大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R657.42

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